DuBose Stephanie N, Hermann Julia M, Tamborlane William V, Beck Roy W, Dost Axel, DiMeglio Linda A, Schwab Karl Otfried, Holl Reinhard W, Hofer Sabine E, Maahs David M
Jaeb Center for Health Research, Tampa, FL.
Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.
J Pediatr. 2015 Sep;167(3):627-32.e1-4. doi: 10.1016/j.jpeds.2015.05.046. Epub 2015 Jul 8.
To examine the current extent of the obesity problem in 2 large pediatric clinical registries in the US and Europe and to examine the hypotheses that increased body mass index (BMI) z-scores (BMIz) are associated with greater hemoglobin A1c (HbA1c) and increased frequency of severe hypoglycemia in youth with type 1 diabetes (T1D).
International (World Health Organization) and national (Centers for Disease Control and Prevention/German Health Interview and Examination Survey for Children and Adolescents) BMI references were used to calculate BMIz in participants (age 2-<18 years and ≥ 1 year duration of T1D) enrolled in the T1D Exchange (n = 11,435) and the Diabetes Prospective Follow-up (n = 21,501). Associations between BMIz and HbA1c and severe hypoglycemia were assessed.
Participants in both registries had median BMI values that were greater than international and their respective national reference values. BMIz was significantly greater in the T1D Exchange vs the Diabetes Prospective Follow-up (P < .001). After stratification by age-group, no differences in BMI between registries existed for children 2-5 years, but differences were confirmed for 6- to 9-, 10- to 13-, and 14- to 17-year age groups (all P < .001). Greater BMIz were significantly related to greater HbA1c levels and more frequent occurrence of severe hypoglycemia across the registries, although these associations may not be clinically relevant.
Excessive weight is a common problem in children with T1D in Germany and Austria and, especially, in the US. Our data suggest that obesity contributes to the challenges in achieving optimal glycemic control in children and adolescents with T1D.
研究美国和欧洲两个大型儿科临床登记系统中肥胖问题的现状，并检验以下假设：体重指数（BMI）z评分（BMIz）升高与1型糖尿病（T1D）青少年更高的糖化血红蛋白（HbA1c）水平及严重低血糖发作频率增加相关。
采用国际（世界卫生组织）和国家（疾病控制与预防中心/德国儿童和青少年健康访谈与检查调查）的BMI参考标准，计算纳入T1D Exchange（n = 11435）和糖尿病前瞻性随访研究（n = 21501）的参与者（年龄2至<18岁，T1D病程≥1年）的BMIz。评估BMIz与HbA1c及严重低血糖之间的关联。
两个登记系统中的参与者BMI中位数均高于国际及各自国家的参考值。T1D Exchange中的BMIz显著高于糖尿病前瞻性随访研究（P <.001）。按年龄组分层后，2至5岁儿童在两个登记系统中的BMI无差异，但6至9岁、10至13岁和14至17岁年龄组存在差异（均P <.001）。在所有登记系统中，较高的BMIz与较高的HbA1c水平及更频繁的严重低血糖发作显著相关，尽管这些关联可能无临床意义。
超重是德国、奥地利尤其是美国T1D儿童中的常见问题。我们的数据表明，肥胖给T1D儿童和青少年实现最佳血糖控制带来了挑战。
